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Oren Berkowitz, Kristen Jones, L. Dade Lunsford, and Douglas Kondziolka

P atients , physicians, payers, and government agencies all are interested in the provision of quality health care. However, the definition of a quality intervention remains unclear, and methods to define and determine quality have not been easily incorporated into medical practice. We defined quality surgery as one that meets the jointly determined goals of the patient and physician with minimal error. The goal of this study was to measure outcomes related to goals that were defined before the procedure. We chose stereotactic radiosurgery as our test

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Joseph H. Piatt Jr. and Christina E. Freibott

with higher volumes of initial shunt insertions had lower revision rates. In a multivariate analysis, revision rates in the Midwest were higher than in other regions. Variation in the quality of surgical care for children with hydrocephalus appears to be real. A quality metric that can be calculated consistently from readily accessible data and adjusted for risk would be useful for neurosurgeons and neurosurgical practices that wish to compare their experiences with national benchmarks, but no such metric exists. The Revision Quotient (RQ) has been defined as the

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Matthew J. McGirt, Theodore Speroff, Robert S. Dittus, Frank E. Harrell Jr., and Anthony L. Asher

H ealth care in the US is at a defining crossroads. The recently passed Patient Protection and Affordable Care Act, signed into law March 23, 2010, has rapidly and dramatically shifted the focus of health care reform toward a critical analysis of quality in health care delivery. 11 Universal agreement exists among payers, regulatory agencies, and other health care stakeholders that “value measures” taking into account both quality and cost variations should be used to modify physician reimbursement and drive reform. While significant resources are now

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W. Lee Titsworth, Justine Abram, Peggy Guin, Mary A. Herman, Jennifer West, Nicolle W. Davis, Jennifer Bushwitz, Robert W. Hurley, and Christoph N. Seubert

that the pain domain HCAHPS scores for our department were consistently below the national median, we implemented a quality improvement trial to address postoperative pain. While several examples of analgesia protocols were present in the literature, none used an interdepartmental approach, focused on all phases of care, or used quality improvement methodologies. Therefore, using a conceptual health model of pain, we developed a multimodal, interdepartmental, standardized analgesia protocol that followed neurosurgical patients from preadmission to discharge. Our

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Rachel F. Groman and Koryn Y. Rubin

W ith the signing of the Patient Protection and Affordable Care Act of 2010 (ACA or Pub.L. 111–148), the US health system entered a new era in which health care professionals will be held to an unprecedented level of accountability for both the quality and efficiency of the care they provide. Although health care quality assessment and improvement have been integral elements of the practice of medicine for much of the past 2 centuries, historically these efforts have been mostly voluntary, internally driven by organized medicine, and rarely focused on cost

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Anthony L. Asher, Paul C. McCormick, Nathan R. Selden, Zoher Ghogawala, and Matthew J. McGirt

T he National Neurosurgery Quality and Outcomes Database (N 2 QOD) is a prospective clinical registry designed to address the need for high-quality outcome data related to care of patients with neurosurgical disorders. This project description is intended to outline the evolution of the registry and, more broadly, the evolution of practice science methodologies over the past several years. It also attempts to describe the role of this clinical registry in the context of a rapidly changing health care landscape, which is increasingly mandating that

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Nancy McLaughlin, Matthew C. Garrett, Leila Emami, Sarah K. Foss, Johanna L. Klohn, and Neil A. Martin

liability has been provided from national or state survey results or data from medical insurance companies. 5 , 13 , 18 We present a review of liability claims/suits within a tertiary academic neurosurgical department. A detailed review of claim/suit standardized abstracts and comprehensive understanding of contributing factors is reported. Identified opportunities for improvement are integrated in the department’s quality improvement initiatives to improve global care delivered. From this unique perspective, departmental engagement is essential to inspire all health

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Nicholas B. Rossi, Nickalus R. Khan, Tamekia L. Jones, Jacob Lepard, Joseph H. McAbee, and Paul Klimo Jr.

interval since last revision, and underlying diagnosis were predictors. 34 Using 2012 data from the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P), Piatt 24 found that congenital heart disease was adversely associated with shunt failure without infection, but that neuromuscular disease and age < 1 year were protective. However, these were univariate associations and stable multivariate models could not be constructed. The literature continues to evolve in identifying new potential risk factors, but is also inconsistent in that some studies identify

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Faith C. Robertson, Jessica L. Logsdon, Hormuzdiyar H. Dasenbrock, Sandra C. Yan, Siobhan M. Raftery, Timothy R. Smith, and William B. Gormley

H ealth care reform in the United States emphasizes value-based parameters to improve quality, efficiency, cost-effectiveness, and patient experience. 36 Readmissions are a common metric of hospital performance, as 30-day readmissions are associated with increased mortality and cost. 11 , 46 Annual Medicare readmissions alone amount to $17.4 billion, leading Medicare and Accountable Care Organizations to institute financial penalties for high readmission rates. 11 , 23 , 49 Hospitals exceeding particular 30-day readmission rates for pneumonia, myocardial

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Matthew J. McGirt, Saniya S. Godil, Anthony L. Asher, Scott L. Parker, and Clinton J. Devin

are less in the ASC setting, but these cost savings will only be realized across the care episode if the ASC setting provides equivalent (or superior) surgical quality. Therefore, the demonstration of equivalent surgical safety and quality is necessary to determine the relative value (quality/cost) of outpatient versus inpatient ACDF. We analyzed a nationwide, prospective quality improvement registry (National Surgical Quality Improvement Program [NSQIP]) to determine if there is a difference in surgical safety and quality for ACDF performed in the outpatient ASC